Job Description

The Manager, Stars and Quality Improvement Programs plays a critical leadership role in advancing quality performance for the Medicare Advantage population, with a specialized focus on medication-related quality measures. This includes driving improvements in Part D Star Ratings, particularly around medication adherence and comprehensive medication use. The ideal candidate brings deep expertise in pharmacy or medication management and a strong background in Medicare Advantage, HEDIS®, NCQA, and CMS Stars strategy.

WHAT YOU’LL BE DOING

• Provide strategic direction and oversight for all Medicare Advantage quality initiatives, with a strong focus on Part D Star Ratings, HEDIS® medication measures, and year-over-year performance improvement.
• Lead and develop a high-performing team of quality professionals, including staffing, coaching, performance management, and professional development.
• Manage and scale medication adherence interventions (e.g., pharmacy outreach, refill programs, synchronization, and care coordination).
• Collaborate with clinical, pharmacy, and analytics teams to design and implement targeted strategies that improve medication-related outcomes
• Analyze performance trends, identify opportunities, and develop data-driven action plans to close care gaps and enhance adherence.
• Prepare and deliver presentations to executive leadership, clients, and internal stakeholders, providing updates on project status, performance trends, and strategic recommendations.
• Lead client-facing discussions and represent the organization as a subject matter expert in medication-related Stars and quality improvement initiatives.
• Oversee quality dashboard reporting (HEDIS®, Stars, and other metrics) to guide internal strategy, value-based contracting, and performance tracking.
• Ensure CMS audit readiness, including data validation, documentation, monitoring, and corrective action plan development.
• Coordinate efforts to reduce polypharmacy risks and improve therapeutic outcomes through cross-functional collaboration.
• Develop member and provider educational materials to support performance on key quality measures.
• Maintain and update quality-related policies and procedures; participate in policy and quality committees as needed.
• Oversee Vendor relationships (e.g., data abstraction, reporting tools, engagement platforms).
• Support departmental operations including budgeting, resource planning, and contract alignment.
• Partner with the QI Director on team structure, staffing, onboarding, and strategic implementation.
• Serve as a subject matter expert in medication quality measures, CMS Part D guidelines, and NCQA pharmacy-related standards.
• Lead the creation and maintenance of quality policies and procedures; participate in policy committee meetings as needed.
• Prepare and present executive-level reports and updates to leadership, steering committees, and regulatory bodies.
• Serve as a liaison across clinical, informatics, compliance, and executive teams to align strategy and ensure data-informed decision-making.

Qualifications

WHAT YOU'LL NEED TO HAVE

• Active license as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Pharmacist, or related clinical discipline (master’s degree preferred)
• Minimum 7+ years of progressive experience in healthcare quality improvement, with a focus on Medicare Advantage and Stars performance programs.
• Minimum of 3 years of experience managing or supervising staff, including team development, mentoring, and performance management.
• Deep expertise in Part D Star Ratings, HEDIS® medication measures, NCQA pharmacy standards, and CMS regulatory expectations.
• Proven ability to design and execute data-driven quality initiatives that improve Stars metrics and clinical outcomes.
• Strong cross-functional leadership experience, working with clinical, analytics, operations, and provider engagement teams.
• Skilled in interpreting complex performance data and developing actionable strategies to drive improvement.
• Excellent verbal and written communication skills, with experience presenting to senior leadership and clients.

WHAT WE WOULD LOVE FOR YOU HAVE

• Certification in healthcare quality (e.g., CPHQ).
• Experience developing provider performance incentives or value-based care models.
• Experience leading adherence improvement programs in collaboration with PBMs or retail pharmacies.
• Familiarity with Population Health Management and Social Determinants of Health (SDoH) strategies.
• Experience with member engagement programs to boost CAHPS and HEDIS scores.
• Knowledge of predictive analytics and risk stratification to target population health interventions.
• A track record of leading cross-functional teams to meet or exceed Star Rating goals.
• A proven record of achieving 4+ Star Ratings across medication measures in a Medicare Advantage setting.
• Experience developing and maintaining quality reporting dashboards, translating performance data into strategic action.

Additional Information

_ The base pay range for this role is between $95,000.00 and $105,000.00 per year._

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

• We are Driven by A ccountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always L earning — staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative I nnovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every V oice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
• And through E mpathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive — together — at Guidehealth.

BENEFITS:

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test here to confirm your internet connection meets these requirements.